DREAM (formerly Harlem RBI) Team Enrichment 2017-2018 Interest Form
Youth Interest form for Grades 6-12
Youth Name *
Your answer
Youth Gender *
Parent/Guardian Name *
Your answer
Parent/Guardian Name Relationship *
Your answer
Youth Birth Date *
MM
/
DD
/
YYYY
Youth Age *
Your answer
School *
Your answer
Current Grade *
Region
Street Address *
Your answer
City, State *
Your answer
Zip Code *
Your answer
Parent Phone Number *
Your answer
Youth Phone Number
Your answer
Parent Email Address
Your answer
Youth Email Address
Your answer
Family Primary Language *
Your answer
Medical Conditions- Check all that apply
Allergies- Check all that Apply
Do you receive Free or Reduced Lunch
Have you played Baseball/Softball Before
If yes, Where? What position?
Your answer
What other After School Programs are you involved with?
Your answer
What days are you available for Programming?
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